Healthcare Provider Details

I. General information

NPI: 1063571867
Provider Name (Legal Business Name): EYECARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 MOODY PKWY
MOODY AL
35004-3062
US

IV. Provider business mailing address

PO BOX 207243
DALLAS TX
75320-7255
US

V. Phone/Fax

Practice location:
  • Phone: 636-200-4393
  • Fax: 205-640-2025
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberS945TA510
License Number StateAL

VIII. Authorized Official

Name: DR. JAMES WACHTER
Title or Position: OPTOMETRIST
Credential: OD
Phone: 636-200-4393